F.E.A.S.T's Around The Dinner Table forum

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JJMom
Hi, haven't posted in a while, but feeling a bit lost now. And be forewarned, this is a bit long.

My 16 yr old daughter was diagnosed last spring with restrictive anorexia. She's been seeing dietician and therapist and making progress, has been mostly weight restored since late summer. We were lucky - we "caught" it very early - and although her weight is better, mentally she's still fighting it. 

At an appt with her dietician a few weeks ago, dietician said she thinks daughter is doing really well. That made daughter very upset, as she obviously equates "doing well" with "being fat". Since then, she's become vegetarian. She wanted to do that earlier, but pediatrician and dietician both told her no, not now, not until she's fully recovered for a while. Well, she's doing it anyway. Dietician said don't fight it, take it in stride, she thinks daughter will go back to eating meat after a while. So, I told daughter I don't agree with her decision to go vegetarian, but I will support her anyway, to which she thanked me for taking that approach. Since then I've tried to make vegetarian options for dinner and she rejects anything vegetarian that I cook for her. She just wants to control all her own food. I will say that we never did FBT, dietician and therapist both thought she wasn't so far gone that we needed to do that, and besides, she is STUBBORN, we wouldn't likely be successful with that anyway. 

Daughter is rebelling against me, personally, in other ways. Loves being with her dad and brother, no problem with them, just seems to be withdrawing from me. I'm obviously taking it personally, as it hurts very much. I am seeing a therapist as well to help get through this. 

At this point I don't know what to do. Feel like I should just make dinner for husband and son, have options for daughter fo fix for herself, but leave her alone. I feel like she thinks I'm trying to control her through her eating, even when I support her choices. Like I said, she is rebelling in other ways, and when I try to relax and be accepting instead of freaking out, she seems thrown by that, doesn't seem to like it. She told me her therapist thought she was too "enmeshed" with me, and I feel like now she's trying to establish some independence and identity of her own (which is great, healthy thing for her to do), and just the fact that I'm even here is troublesome to her. 

So, other than working through these feelings of control, independence, etc. with her therapist and mine, what should I do about dinners? Should I just make meals for the rest of the family and let her "fend for herself", which seems to be what she wants? Her weight is staying stable to this point.
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Kali

Dear JJMom,

Sorry your daughter is struggling so much.

I'm hearing some unhelpful comments from the professionals that you might want to give some gentle pushback on behind the scenes. If you are in the US and your daughter is a minor, you are entitled to be able to get in touch with any provider and tell them of your concerns.

The first:

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At an appt with her dietician a few weeks ago, dietician said she thinks daughter is doing really well. That made daughter very upset, as she obviously equates "doing well" with "being fat". 

For this one, I might suggest phoning the dietician and mentioning what happened here and caution her against saying your daughter is doing well again. Does the dietician weigh her? Blind weighing could be an option at this point and no commentary on how she is doing from the dietitian. Just a smile and a thank you after she gets off the scale.

As far as this comment from the therapist:

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She told me her therapist thought she was too "enmeshed" with me, and I feel like now she's trying to establish some independence and identity of her own (which is great, healthy thing for her to do), and just the fact that I'm even here is troublesome to her. 

Have you heard of Hilde Bruch? She was the psychoanalyst who worked on that enmeshment theory a very long time ago—like in 1973 or thereabouts. Before much of the modern research about eating disorders that we know about now which takes genetics and the fact that eating disorders are a brain based mental illness into account. In those days, it was believed that the parent, especially the mother, became "enmeshed" or too over involved with the child and that this in some way contributed to the eating disorder. And it all somehow had roots in early childhood. That led to Salvador Minuchin, a psychiatrist who passed away a few years ago, developing something called family systems therapy. It was important because despite everything it was the first time the power of the family was considered in eating disorder treatment. It is interesting to read about in a historical sense, however there have been so many advances since then that it is now generally understood that parents are part of the solution, NOT part of the problem and that "enmeshment" doesn't contribute to the eating disorder but in fact families who support regular mealtimes and full nourishment are more likely to see a positive outcome with this illness.

Unfortunately for us parents, there are still some therapists who seem to cling to this outdated way of thinking. So this brings up a pretty big red flag. This is a great way for your daughter's eating disorder to advocate for what it wants: for you not to require her to eat and for you not to feed her. Look you are already considering letting her make her own food while you make dinner for your husband and other child. This is exactly what the eating disorder would like because it will most likely allow your daughter to eat less while pushing you, the person who wants her to eat, away.

In your shoes I would make dinner for the whole family and have her join you to eat it, while keeping her out of the kitchen while you prepare it. Is it a coincidence that this discussion about "independence" is coming up around the time that she learns she is "doing well" ???(meaning she is gaining weight) It seems as though the eating disorder is trying to triangulate a way to eat less by getting you to back off supported by the therapist.
I can tell you that we had a dietitian who also started talking about independence and letting my daughter eat on her own when it was really too early, and I allowed her to go away on a trip with friends for 3 weeks and feed herself. A skeleton walked into my house when she arrived home. When we went to see the dietitian I was pretty peeved but kept my demeaner pretty low key and non critical. She told me to bring my daughter home and feed her and we never again had a discussion about her "independence" or letting her take more "control" over her food. We didn't have to because the next time I let her do it, many months later she was actually ready to try.

Typical teens don't mind eating dinner with their parents and having whatever is on the table and in the end the goal is to normalize eating. Kids with eating disorders do mind that. But there are several choices here: you can let her have more opportunity to feed herself for say, a week, and if she loses weight she also loses that privilege, or you can just insist that normal kids eat with their families and have her do that. 

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Since then I've tried to make vegetarian options for dinner and she rejects anything vegetarian that I cook for her. She just wants to control all her own food

This is also a pretty big red flag. She says she wants to be a vegetarian and then rejects the vegetarian food what you make? 

Anyway I hope that this will give you some food for thought as they say, about how to proceed.

warmly,
Kali

Food=Love
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Foodsupport_AUS
Sorry that you have hit this stumbling block.Kali has given you some great ideas. The fact that hearing she was doing well seems to have been a trigger for much of this says much more that it is ED rather than teen independence. My D could not hear she was doing well or better for some years. 
I have to agree that her rejecting your meals is part of the eating disorder and does not sound like normal teen independence. I am yet to hear of a teen without an ED who is expressly choosing to prepare their own foods separately from the rest of the family. I would be asking for support from your husband as well to make it clear - all meals are being prepared and eaten together. The vegetarian part is also likely to be ED as well, how much you push back against this depends on the situation. 
D diagnosed restrictive AN June 2010 age 13. Initially weight restored 2012. Relapse and continuously edging towards recovery. Treatment: multiple hospitalisations and individual and family therapy.
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MKR
Hi @JJMom ,

Great that you have come to state your situation on the forum - and timely!

Nothing to add to the above on the ED red flags, just some other points:

1. Please enlist your husband to have your back in refeeding. Like keeping her busy and away from the kitchen while you cook.  You guys can use his current popularity to beat the ED.
And also with some behaviour boundaries or house rules, ie no insults or any physical abuse. That way the ED will not be able to divide and conquer. 

2. Great that you have got therapy for self-care. It can be soooo draining this daily annihilation... the dad and I are still the least popular people in our 16-y-o D's life.

I feed on the memories of the loving toddler and the school girl - and the tiny glimpses of approval she gives from time to time.  Also, from the other d's show of love.

But boy can it get so tiring! Then it dawns on me that the mantra is same, same repetition. So I say, "Yes, I have heard your insults. Now just finish your food."

Sometimes I fight back with humour (NOT sarcasm). And I capitalise on the quiet times when she asks for a shoulder massage.  We then have great chats about non-ED stuff and laughs, too.

I hope that the tips at 2. are of help to you!

All the best ❤❤,
Mum's Kitchen

14-y-o "healthy living" led to AN in 2017 and WR at 16. Current muscle dysmorphia.
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JJMom
Thank you all for your comments, they were very helpful. I'll have private discussions with the dietician and the therapist about this. I've also talked to my husband and he says I cook, she eats what I cook. I appreciate having this forum as a place to come to and to get some great information. 
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ValentinaGermania
JJMom wrote:

My 16 yr old daughter was diagnosed last spring with restrictive anorexia. She's been seeing dietician and therapist and making progress, has been mostly weight restored since late summer. We were lucky - we "caught" it very early - and although her weight is better, mentally she's still fighting it. 


Why is she seeing a dietitian? I think this is not helpful at all. In FBT normally the patients do not see a dietitian. Too much talk about food.

JJMom wrote:
At an appt with her dietician a few weeks ago, dietician said she thinks daughter is doing really well. That made daughter very upset, as she obviously equates "doing well" with "being fat". Since then, she's become vegetarian. She wanted to do that earlier, but pediatrician and dietician both told her no, not now, not until she's fully recovered for a while. Well, she's doing it anyway. Dietician said don't fight it, take it in stride, she thinks daughter will go back to eating meat after a while. So, I told daughter I don't agree with her decision to go vegetarian, but I will support her anyway, to which she thanked me for taking that approach. Since then I've tried to make vegetarian options for dinner and she rejects anything vegetarian that I cook for her. She just wants to control all her own food. I will say that we never did FBT, dietician and therapist both thought she wasn't so far gone that we needed to do that, and besides, she is STUBBORN, we wouldn't likely be successful with that anyway. 


This is nothing the dietitian or your d should decide. It is up to you what you serve. She can be a vegetarian when she is adult and recovered. Up to then you are in charge.
If she wants to eat vegetarian she needs to eat what you serve anyway. She only chose to be vegetarian to be able to restrict again and to get into control about food again.
What the hell is that? How far do you need to go to need to do FBT? I never heard of that. Do they mean your d is not sick enough for FBT? Big mistake in their thinking then...
And they are all stubborn, that is part of their pre-ED -character. I never met one ED child up to now whos parents did not complain she/he is stubborn...


JJMom wrote:
At this point I don't know what to do. Feel like I should just make dinner for husband and son, have options for daughter fo fix for herself, but leave her alone. I feel like she thinks I'm trying to control her through her eating, even when I support her choices.


NO. This is ED and you should not give in to ED. You are in charge, you serve, for ALL of you. This has nothing to do with control from you. It is ED that tries to get in control of her again.

JJMom wrote:
Like I said, she is rebelling in other ways, and when I try to relax and be accepting instead of freaking out, she seems thrown by that, doesn't seem to like it. She told me her therapist thought she was too "enmeshed" with me, and I feel like now she's trying to establish some independence and identity of her own (which is great, healthy thing for her to do), and just the fact that I'm even here is troublesome to her.


Now all my alarm bells are ringing. What kind of old fashioned therapist is that??? Please check what they are doing there...this does not sound like modern ED therapy, it sounds like old fashioned seeking for underlying issues and "faults" in the families...
Is there no ED professional she can go to in your area? If not, no help is sometimes better than bad help...
Keep feeding. There is light at the end of the tunnel.
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Frida
I’m new here—My D turned 18 recently, and was diagnosed w restrictive AN in July, when she entered an in-patient hospital program. She weighed 104lbs at 5’8.”  We think her ED started back in April, or at least, that is when it became noticeable to us. She went from 132lbs to 104lbs within a 5 month period. We took her to her pediatrician a few times during this period to be sure she wasn’t sick and wanted to rule out things like PANDAS. She hadn’t had a period in 2 months, and the doctor noticed a double heart beat, which is what put her into the hospital program. We learned that she was eating only 500 calories a day. She works in a restaurant and would tell us that she ate at work when we didn’t see her having dinner. She would say she ate lunch at school, or went out w friends for meals. We were clueless- we believed her. She stayed in the hospital for 5 weeks and wanted to leave in order to start school on time. We took her  AMA, because she promised she would continue with her recovery, and she had the support of a dietician and therapist. She was a resistant patient in the hospital. She was placed in a pediatric unit, at 17 yrs old, being the oldest child there. She did not do well with the restrictions on her movement/ privacy/ freedom to leave or even see friends. Group therapy was difficult because of the maturity differences, and individual therapy was spent talking abt the ED and not the root causes of it. She was diagnosed as restrictive because she has been a vegan since she was 14 (ethical reasons) and had a very hard time re-feeding due to having to eat many things she hadn’t eaten for years. She developed gastrointestinal issues while there, and her anxiety and depression skyrocketed to new levels. She even called a meeting with her hospital team and filled out paperwork to sign herself out. She has had a history of depression/ social anxiety/ panic disorder since she was a 15. She has tried multiple CBT therapists, and has not stayed with any of them for more than a few months, stating that she doesn’t want to talk to them, and that they can’t help her. She has gone to psych meds drs, been placed on anti-depressants/ Lithium/ Adderall/ Xanax ( not all at once), and nothing has worked. One doctor thought she was bi-polar, but those meds didn’t work either. Currently, she is on Remeron (prescribed while in-hospital) and she says that it isn’t working. She has had genetic testing for psychiatric drug/addiction tendencies done, but that wasn’t much help. I don’t even know if it was worth the $$$. She has relapsed, and is currently at a lower weight than when she first went into the hospital. Everyone on her support team, including her school, says she needs to go back in-patient, but she says she is 18 now and will refuse to go, and if forced, will sign herself out and refuse treatment. She told us the hospital made her mental state unbearable. Her dietician no longer wants to see her and doesn’t want to accept responsibility if something should happen. She has taken to not speaking during therapy, which is now being called “selective mutism” ( which I am calling BS), and we are at a loss of what to do. She is determined to let us allow her to re-feed herself, but she is so afraid to gain weight that she is adding calories 20-30 calories at a time. She doesn’t want to be hospitalized before Christmas, and we do have a doctor appointment for her right afterwards. If the doctor finds any heart irregularities, she will be back in and she knows there is no exception to this. We are working with a therapist who does EMDR, but it’s not an immediate fix. We know she needs more support, but cannot figure out a way to get her to go to the hospital voluntarily. She has to want to recover, and she sometimes wants to, but not always. We are in agreement that her mental state suffered while in-hospital. She cried for hours every day. The hospital will address her physical concerns, but the mental concerns are just as important. Lastly, the dietician is monitoring her weight every week, and checking her food journal— however, she communicates food plans in exchanges like the hospital used. Is this how all dietitians working with ED do it?
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Frida
What does FBT mean? I’m new to the abbreviations—
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ValentinaGermania
FBT is family based therapy, the gold standard with anorexia
Would you like to open your own thread with the new topic icon on the right top? I think it would help you to be seen more here and to get more replies.

"She has to want to recover, and she sometimes wants to, but not always."
That is something that is different with FBT. In FBT the patient does not need to want to recover (because most patients cannot want that while very sick), the only thing the patient needs to to is eat.
Keep feeding. There is light at the end of the tunnel.
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Enn
Hi there Frida,
i am sorry that you needed to find us. But I am glad you are here. I hope you will find the information and support you need.
FBT is Family based treatment not therapy as per the original researchers although some use the terms interchangeably.
http://www.maudsleyparents.org/whatismaudsley.html
 
It sounds as if that is what you have been doing on and off?
please ask all the questions you have. We really do wish to help.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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Aggie
Hi Frida,
I assume she is still at home with you?
I used the tack, we can do this at home or you can go into hospital and neither of us want that, we can do this and we can do it together. We side stepped two hospitalisations and that stayed in the background in case we needed it. 
Take control of her meals and her snacks and tell her it's non negotaiable if she wants to stay out of hospital (I don't know how it works there, but as I understand here someone over the age of 18 can be sectioned under the mental health act for their own safety).  Tell her food is her medicine, it was a mantra I repeated constantly in the early days ' if you had a chest infection, you would take antibiotics, this is no different' 'if you had diabetes, you would need insulin, this is no different, food is medicine'. Your D has already said that she wants to refeed herself so run with it and say yes, we can do it together as long as she lets you take control.  There are lots of wise words on here with regard to adding in extra calories with canola / rapeseed oil. Have a look around the threads.
If it makes you feel any better, my daughter has never, ever spoken to anyone during any form of therapy in 3 years, every appointment was embarrassing. Our team started CBT with her and it was pointless because she wouldn't engage as hard as they tried ( I believe The Ed wouldn't allow her to say anything that might help someone help her) BUT we are finally in a good place, we have fed and fed and fed her and loved her unconditionally (and argued a lot along the way!) and now it looks like brain recovery is coming, she eats a great variety of food, given the choice will even opt for more calorific things that she enjoys rather think about calories.
Use the fact that you have a doctor appointment right after Christmas as the incentive to get things moving. Good luck x
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Kali

Hi Frida,

I'm wondering if you would like to start your own thread and that way you will be able to get answers for your specific situation from the wise community here. If you click on new topic on the top right you will be able to create it.

But anyway, welcome to ATDT. I hope you will find good support here. I wanted to steer you to some resources you can take a look at if you would like.
First, a couple of books.

https://www.amazon.com/When-Your-Teen-Eating-Disorder/dp/1684030439
When your teen has an eating disorder by Dr. Lauren Mulheim.

Eva Musby's website:
https://anorexiafamily.com/?v=7516fd43adaa
She has an excellent book called Anorexia and Other Eating Disorders which has some practical advice about how to feed your daughter.

And of course the FEAST website and the family guides:
http://www.feast-ed.org

https://www.feast-ed.org/family-guide-series/

It would appear that your daughter is at a very low weight. 

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 She has relapsed, and is currently at a lower weight than when she first went into the hospital.  


As far as I can figure from what you said she weighed when she went into the hospital, that means that her bmi is currently lower than 15.8. I would urge you to get medical help for her. I know you said you have an appointment after the holidays; do you mean after the 26th or the first week of january? Even though she is 18, unfortunately she didn't wake up on her 18th birthday able to make good choices about her health or food, so as her parent, you will need to step in and make sure that happens no matter how resistant she is. Others have been able to do this and you will be able to do it also. 

So to go through some of the things you have mentioned trying:
There are no drugs which, at this time, have been approved to treat anorexia so it is no surprise that none of them are working.
There is one drug, an atypical antipsychotic called Olanzapine which some families have reported made it easier for their child to eat and there have been some studies showing that may be the case and result in some weight gain while on it.. 
SSRI's such as prozac are approved to treat Bulimia, if your daughter is purging.
EMDR as far as I know, is often used with people who have suffered trauma. 
FBT has been studied and can be helpful in the case of eating disorders.
CBT and DBT have also been studied and can be helpful with depression, anxiety and ruminating thoughts.

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We took her AMA, because she promised she would continue with her recovery, and she had the support of a dietician and therapist


If she goes into the hospital again I would advise against taking her out AMA no matter how many things she finds to complain about. She will promise you the world, however you now see that it is not working and she is not eating enough and in fact is treatment resistant and now at a lower weight instead of continuing with recovery as she had promised. She most likely wanted to leave the hospital so she could eat less. Of course she found it unpleasant to not be able to move around. Moving excessively is also a symptom. As far as therapy goes, IMO the center was correct to base it on the eating disorder, and not on any "Root Causes". Eating disorders are biological brain illnesses with genetic underpinnings and as such, you can spend time trying to find a root cause for years however the medicine is food and the treatment is weight restoration while resuming a normal diet. 

For someone with an eating disorder, Veganism is not a lifestyle or ethical choice. It is a symptom and is very common with those who have anorexia. It will be very difficult to refeed your daughter without dairy products, and it puts her bone development at serious risk for osteoporosis to not be eating dairy. 

So really the question is how can you support her to eat more and restore her weight and find effective treatment?
There is a thread you can take a look at called How did you get your child to eat which perhaps can give you some ideas.

https://www.aroundthedinnertable.org/post/how-did-you-get-your-child-to-eat-10375136?pid=1310320723

If your daughter needs residential treatment there is an excellent program at Columbia Medical Center in NYC. They use evidence based treatments. 

https://www.columbiapsychiatry.org/research-clinics/eating-disorders-clinic

Please ask all the questions you need to. There is usually someone around.

warmly,

Kali

 

Food=Love
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Frida
I am overwhelmed by the kindness and support here— thank you for taking time out of your family lives to respond to me. I have read so many helpful things and tried to apply them today, with good results. She was having a lot of anxiety today and thought that these meds were not working. I told her that she can’t tell if the meds are working or not when she is not feeding her brain properly. Told d. that I will no longer allow her to measure her food w spoons and cups, and that she is to eat what I prepare for her, (I will keep it vegan), if she wants to stay out of the hospital. She resisted the idea, and got upset. She didn’t think she could do it. I encouraged her to try so she could enjoy eating with friends again—she stopped hanging out w friends when the ED started. She cried and went to her room. Later, she came downstairs and told me that she would eat the dinner I was preparing for her, and then—-I was so surprised—she asked me if I would share a piece of candy w her! She has not spontaneously eaten anything in months! She got 2 peanut butter cups and we clinked them before we ate. She and I cried while she ate hers, but she did eat it. It was the best peanut butter cup I ever ate! She ate dinner w us and took a regular portion of food, and ate the whole thing! We didn't acknowledge what she was doing and talked abt other things w her—again, something we haven’t been able to do, being so focused on her ED. I hope this will continue. I also shared the TED talk Elizabeth Huh gave abt AN. I think my d. will relate to it. Thank you, thank you to all of you! I was really in despair, and now feel a glimmer of hope. 
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Enn
That is wonderful news, Frida!!
you handled the meal and upset exceedingly well!
Keep going!
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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ValentinaGermania
Wow, that is really great news and not only a small glimpse of hope!
If you could work on that in the next days and that would be great! Keep going!
You see that she desperately want to eat sweets and be normal again, you can help her with that.
RE veganism, it is a start to get her to eat what you serve but for the long run please know that in most cases veganism is an ED idea and your d inside wants to eat normal food and needs that. It is possible to refeed and get healthy on a vegetarian diet but veganism does exclude you from many social events and allows a lot of restricting and I personally would not allow that in my house.
But you can work on that later. Now it is important to get her to eat all meals with you. Step by step, day by day. You can do that! You already see that it works. If you require eating you can be stronger than the ED in her head that forbids eating.
Keep feeding. There is light at the end of the tunnel.
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